Armando Hasudungan
Biology and Medicine videos

Angina Pectoris

Overview

Overview Angina Pectoris refers to the pain caused by myocardial ischaemia. Myocardial Ischaemia is usually caused by stenosis within the vessel decreasing blood flow to the muscle, but it can be caused by tachycardia, anaemia, aortic stenosis, left ventricular hypertophy and many other disease. Angina “latin choking”.

Definitions
Angina Pectoris: Pain caused by myocardial ischaemia (not myocardial infarction)
Acute myocardial Infarction: Death of myocardial tissue because of inadequate blood flow
Acute coronary Syndrome:
Coronary artery obstruction or rupture can result in a variety of ischaemic condition which fall under the term of acute coronary syndrome. This does not include stable angina.
Unstable angina is defined by the absence of biochemical evidence of myocardial damage. It is characterised by specific clinical findings of prolonged (>20 minutes) angina at rest; new onset of severe angina; angina that is increasing in frequency, longer in duration, or lower in threshold; or angina that occurs after a recent episode of MI.

Risk Factors

Modifiable Non-modifiable
Smoking Increasing age
Hypertension Male sex
Dyslipidaemia Family history
Diabetes mellitus Ethnicity
Obesity
Physical inactivity
High calorie intake diet
Psychological stress

Types

Angina is classified according to its temporal pattern and its relation to exertion

  • Stable angina – angina only on exertion
  • Unstable angina – angina on exertion or at rest
  • Crescendo angina –
  • Decubitus angina – angina by lying flat
Remember Unstable Angina is part of Acute Coronary syndrome. Stable angina is NOT part of acute coronary syndrome

Signs and Symptoms

Rule out acute coronary syndrome if presenting to Emergency. Stable angina chest pain typically resolves with rest.

  • Chest discomfort (non-sharp pain)
  • Dyspnoea
  • Fatigue
  • Nausea/Vomiting
Remember Myocardial Ischaemia will respond to nitrates almost immediately
Think Chest wall tenderness suggests musculoskeletal pain and does not accompany angina

Differential Diagnosis

CAUSES OF CHEST PAIN BY BODY SYSTEMS
Cardiac Respiratory Gastrointestinal Musculoskeletal Psychogenic
Acute Coronary Syndrome Pulmonary Embolism Oesophageal rupture Rib Fracture Anxiety
Aortic dissection Pneumothorax Pneumomediastinum Herpes Zoster Panic attack
Pericarditis Pulmonary Hypertension Cholecystitis Costochondritis
Stable Angina Pneumonia GERD
Endocarditis Lung Cancer Peptic ulcer disease
Cardiac tamponade Bronchiectasis Acute Pancreatitis

Investigations

  • FBC
  • EUC
  • Blood glucose leves
  • Lipid Profile
  • Chest X-ray

Test to induce ischaemic chest pain

  • Exercise ECG
  • Stress echocardiography
  • Myocardial perfusion scanning

Management

Non-pharmacological

  • Education
  • Smoking cessation
  • Alcohol limitation
  • Lose weight
  • Exercise
  • Healthy diet

Pharmacological (BANS)

  • Betablockers (calcium channel blockers if contraindicated)
  • Aspirin
  • Nitrates
  • Statins
Pharmacology Aspirin is a COX 1/2 inhibitor. It prevents the production of Prostagladins (inflammation: fever and pain) and thromboxane (clotting). It is used to treat fever, osteoarthritis, heart conditions and stroke. Side effects: nausea/vomiting, dyspepsia, stomach ulcer or bleeding problems, headache, dizziness, tinnitus, renal dysfunction and Reye’s syndrome (particularly in children who have taken aspirin)
Pharmacology Statins are competitive HMG-CoA reductase inhibitors, an enzyme normally responsible for producing cholesterol. By lowering the levels, they help prevent heart attacks and stroke. Side effects: Headache, difficulty sleeping, flushing of the skin, myalgia, liver enzyme dysfunction, nausea or vomiting, abdominal cramping or pain, bloating or gas and serious cases myositis and Rhabdomyolysis

Watch Video Acute Coronary Syndrome

 

 

Complications

References

BMJ
Best Practice
UpToDate